With NSW’s only public long covid in-person clinic closing, GPs have been left holding the bag for caring for these complex, chronic conditions.
After three and a half years, St Vincent’s Hospital Sydney has announced it is closing its dedicated long covid service.
The hospital said it is now recognised that post-covid symptoms are well managed within established specialist chronic and complex care services, prompting the closure.
“This is the widespread and standard clinical practice across NSW’s health services and in other states.
“As a result, St Vincent’s Sydney will begin transitioning patients from its Long Covid Service into its existing respiratory and rehabilitation services, as well as other specialist services as appropriate, from the end of September,” a spokesperson for St Vincent’s Hospital Sydney said in a statement.
The hospital maintained there were no specific funding, staffing, or operational challenges that led to the closure. However, it was only funded for 12 months by NSW Health and since then has been philanthropically funded.
A spokesperson from NSW Health told Allergy & Respiratory Republic that most people with long covid will be supported by their GP, with referral to specialised clinics for people who meet escalation criteria.
“GPs have access to the post covid conditions health pathway, which provides consistent clinical management and referral information for relevant clinics or local district-based integrated care teams,” said the spokesperson.
However, according to GP and chair of the RACGP’s Specific Interest Energy-Limiting, Post-Infectious Conditions (ELPIC) group, Dr Bernard Shiu, reduced funding for GPs makes it difficult.
“The funding for GPs has already been going down for many years. These conditions are very complex, and patients require longer time to be with the GPs,” he said.
“The government is not encouraging that to happen, and longer consults aren’t properly rebateable. So, these what we call ‘invisible conditions’ become very difficult to manage without the proper funding and support from the government.”
Emeritus Professor Jennifer Alison from the University of Sydney said that while some GPs might have an interest in long covid and could manage it well, others might struggle.
“Often when you can’t find an absolute pathophysiological cause for a condition, people often thought that there’s a large psychological overlay, which means that they’re not necessarily treated appropriately.
“I think it is a condition that’s real and that people need to get the support of a surround clinic that understands what these people are going through,” she said.
NSW Health said GPs might choose to refer patients directly to public or private specialist clinics.
“Patients with multiple symptoms which reduce ability to perform everyday tasks or activities are generally best managed in local multidisciplinary rehabilitation clinics. Care delivered at these clinics is specific to the symptoms and individual needs of each patient and may be provided virtually or in-person, depending on the service model used,” said the spokesperson.
As Professor Alison explained, the problem is there are very few, and with the closure of St Vincent’s, even fewer.
“RPA does have a telehealth long covid clinic where people can talk to psychologists.
“Patients who are within the catchment of St Vincent’s can go to their pulmonary rehabilitation clinic, but there are many people that don’t have access to those kinds of services.
“The [number of] people with expertise in managing the rehabilitation of people with long covid is also limited across the state.
“There needs to be more opportunity for those services to be more widely available, or at least a place where they’re available,” she said.
Dr Shiu knows all too well about the demand for services. He set up a dedicated long-covid clinic in Geelong in 2022.
“We’ve looked after close to 1000 patients now, and those are the patients that could not get any public hospital clinical support, and they ended up being managed by their own GPs, or they ended up coming to our clinic to seek care,” he said.
Since then, he has been advising on how to deliver long covid care in the community and just chaired the second long covid conference.
“Last week at our long covid conference, we had professors from the UK, professors from the US that spoke to us face-to-face about how much funding the Trump government is putting in long covid, same thing with the UK government and our government is actually cutting. It’s just ridiculous,” he said.
“I feel sad for the patients in the community who are suffering in silos because they just can’t get any help. Many GPs want to help but we are quite limited by what we can do as well, because sometimes we really need that hospital specialist to help us,” he said.
Professor Alison agreed.
“We need somewhere for people who have really severe symptoms to go and be seen by a group of health professionals who understand the condition.
“I think the difficulty is whether one hospital should bear the cost of picking that up,” she said.
